Abortion facilities in Virginia have undergone facility inspections since 2012. Virginians now have first-hand knowledge of what to expect inside. While abortion facilities and abortion activists claim inspections are unnecessary, inspections over the last 6 years continue to show otherwise. Initial inspections showed hundreds of pages of violations. VDH developed a scope and severity index, similar to what is used within the nursing home industry, and applied it to the abortion facility inspections. VDH inspectors found “widespread deficiencies with potential for more than minimal harm to patients” in all but two abortion facilities, which at that severity triggers a revisit to ensure compliance. Maybe one could expect a learning curve with the initial round of announced inspections. But in the more recent biennial inspections completed in 2016, “widespread deficiencies with potential for more than minimal harm to patients” continued to be found in 80% of the facilities. One facility alone had 144 pages of violations! And that does not even consider another facility where the inspection led to the indefinite suspension and ultimate closure of the facility.

Abortion facilities are proving that the regulations as written are working. There is no need to scale back when inspectors continue to find egregious examples of deficiencies across the board. Let the inspectors continue to do their jobs.

If there is any doubt that the regulations are needed and should continue as written, if not emboldened, one need look no further than the most recent set of biennial inspections. Here are a few of the violations cited:

• Staff members improperly trained and/or unaware of basic sanitation and disinfecting procedures for infection control, such as not cleaning surfaces/instruments between patients
• Staff members unaware of basic infection prevention, such as not wearing masks or gowns during procedures, not performing hand hygiene during direct patient care, physician never washing hands but just uses gloves
• Staff members improperly trained and/or unaware of how to handle Biomedical Waste, such as storing waste in non-refrigerated areas designated as “clean”
• Numerous drugs that were in use were expired.
• Staff members handling controlled substances without the required background check
• Not verifying the credentials and licensure of operating physicians
• No system for logging and processing complaints
• Mandatory reporters unaware of requirement and how to report suspected child abuse and neglect
• Facility that sits in a zone known for sex-trafficking performed abortions on minors without parental consent. Facility failed duty to report child abuse.
• Medical records for patients lacked the attending physician’s signatures for ultrasound confirmations, abortion procedures, discharge orders, and anesthetic requirements
• Numerous cases of nurses not documenting charts
• Facilities having no one trained in advanced cardiac life support (ACLS)
• Staff members administering narcotics without a physician’s orders – one unlicensed staff member prepared narcotics for 20 years!
• Staff improperly interacted with, kept no records of, and transported Schedule II narcotics
• Standing orders required the attending nurse to make a decision regarding the amount of medication to administer which is beyond the nurse’s scope of practice.
• Sterile suturing equipment and supplies were not available when a patient experienced prolonged bleeding after a procedure and the patient had to be transported to the local emergency department for care.
• Failed to investigate why multiple patients had to return for a second visit to complete the abortion procedure
• Refrigerator thermometers not working, no backup generators when facility goes without power, not following recommended manufacturer instructions for storing drugs
• Fire drills, active shooter drills, disaster preparedness, safety and emergency training not conducted for multiple years

Not only this, but we should continue to ensure Virginians that abortion facilities are doing all that is necessary to comply with the Code of Virginia. In the 2018 GA Legislative Session, SB725 requires all abortion facilities to post the existence of a human trafficking hotline to alert possible witnesses or victims of human trafficking to the availability of a means to report crimes or gain assistance. 12VAC5-412 should include this new requirement.

VDH continues to report that Infection Prevention is the #1 and #2 cited deficiency in abortion facilities. 12VAC5-412 sections 220 and 370 should be bolstered with evidence-based national standards that would help facilities with their infection prevention policies. Two sets of standards that provide great clarity from experts across the country to provide the health and safety of patients across medical disciplines are the CDC’s Guide to Infection Prevention for Outpatient Facilities and the 2018 FGI Guidelines for Design and Construction of Outpatient Facilities.

The National Abortion Federation’s Clinical Policy Guidelines recommends post-abortion counseling services be given to women. 12VAC5-412-230E should reinstate this requirement, as it is an evidence-based guideline and standard, developed by consensus, based on rigorous review of the relevant medical literature and known patient outcomes.

Abortion facilities continue to claim that they are safe, and yet there is no reporting requirement to support that fact with data. Serious complications such as hemorrhaging, infection, perforation, damage to organs, anesthesia complications, and a continuing pregnancy that requires further intervention should be logged and reported. 12VAC5-412-320(B) lists the required reporting. These items should be added to 12VAC5-412-320.B.2.

§18.2-76(B) requires abortion patients to have a physician perform a sonogram in order to determine the gestational age. 12VAC5-412-230(A) causes confusion and purports to lessen that requirement by stating just a licensed health care provider can clinically estimate the gestational age. Why cause confusion where none needs to exist? This language should match that found in the Code of Virginia.

Striking the need for an established relationship with hospitals in case of an emergency continues to be a concern. Can patients be assured that an adequate emergency plan is in place at all abortion facilities without this requirement? All abortion facilities had a written transfer agreement prior to the removal of this requirement in 2017, proving it was no burden on the facilities to obtain, and yet we’ve eliminated this safety feature for future abortion patients.

The Health Commissioner’s own Virginia Plan for Well-Being seeks to improve the quality of health care for all Virginians specifically by lowering the rate of STIs. A previous amendment to 12VAC5-240(A)(3) removed the requirement that abortion facilities screen for STIs. An abortion facility is a prime point of contact for those at high risk for an STI. Reinstating this requirement would incur no further healthcare costs since abortion facilities were already providing these services. And it is just good healthcare policy. Notably, ACOG, CDC, NAF and even the state of Virginia recommend STI screening for sexually active women.

Please keep health and safety standards high for women inside abortion facilities. The evidence derived from VDH’s own inspections over the past six years sufficiently demonstrates not only the need for high standards, but greater accountability through enforcement. We urge the Board not to sacrifice otherwise standard duties of care for the sake of political pandering.